Reduction and temporary fixation

Manual reduction

These fractures produce separate fragments of the proximal humerus: an epiphyseal (humeral head) fragment and one or both tuberosities in addition to the shaft. Reduction involves repositioning the humeral head, and also restoring the tuberosities to their proper location.
The medial periosteum (medial hinge) is not ruptured. Much of the remaining periosteum (especially laterally) may also be intact
As a first step perform a closed reduction taking advantage of the intact soft-tissue sleeve (as with ligamentotaxis). Frequently, the displaced fragments will snap into position with this maneuver.
Valgus forces (abducting at the fracture) can be applied to the lateral aspect of the humeral shaft to correct the varus deformity and facilitate manual reduction.